<link rel="stylesheet" media="screen" type="text/css" href="<?php echo bu("css/datepicker.css"); ?>" />
<script type="text/javascript" src="<?php echo bu("js/datepicker.js"); ?>"></script>
<script>
		$(function() {
      $( ".dpicker" ).datepicker({
        changeMonth: true,
        changeYear: true,
        dateFormat: 'd MM yy',
      });
    });
</script>

<div class='mainContainer home'> <!-- Main div for the contain, behaves like a table-->
	<div><!-- Direct child of mainContainer, behaves like a table cell-->
		<?php // echo $this->renderPartial('/partials/_notifications'); ?>
		<h2 class='differentAlign'>CEDP Registration Form</h2>
		<div class='spacer'>&nbsp;</div>
		<?php
      $form=$this->beginWidget('CActiveForm', array(
      'action' => bu('users/cedp'),
      'htmlOptions' => array(
          'name' => 'myForm',
          'class' => 'myForm customForm',
          )
      ));
    ?>
      <?php echo $form->errorSummary($model); ?><br />

      <fieldset>
        <legend>Data Pribadi</legend>
        <table>
        <tr>
          <td><?php echo $form->labelEx($model,'name'); ?></td>
          <td>
            <?php echo $form->textField($model, 'name', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'name'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'address'); ?></td>
          <td>
            <?php echo $form->textField($model, 'address', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'address'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'postal_code'); ?></td>
          <td>
            <?php echo $form->textField($model, 'postal_code', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'postal_code'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'phone'); ?></td>
          <td>
            <?php echo $form->textField($model, 'phone', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'phone'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'email'); ?></td>
          <td>
            <?php echo $form->textField($model, 'email', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'email'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'birthdate'); ?></td>
          <td>
            <?php echo $form->textField($model, 'birthdate', array('class' => 'dpicker full', 'readonly' => true)); ?>
            <?php echo $form->error($model, 'birthdate'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'job'); ?></td>
          <td>
            <?php echo $form->textField($model, 'job', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'job'); ?>
          </td>
        </tr>
        </table>
      </fieldset>

      <fieldset>
        <legend>Data Sekolah / Gereja / Organisasi</legend>

        <table>
        <tr>
          <td><?php echo $form->labelEx($model,'school_name'); ?></td>
          <td>
            <?php echo $form->textField($model, 'school_name', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'school_name'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'school_address'); ?></td>
          <td>
            <?php echo $form->textField($model, 'school_address', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'school_address'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'school_phone'); ?></td>
          <td>
            <?php echo $form->textField($model, 'school_phone', array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'school_phone'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'school_fax'); ?></td>
          <td>
            <?php echo $form->textField($model, 'school_fax', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'school_fax'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'school_email'); ?></td>
          <td>
            <?php echo $form->textField($model, 'school_email', array('class' => 'full')); ?>
            <?php echo $form->error($model, 'school_email'); ?>
          </td>
        </tr>
        </table>
      </fieldset>
      
      <fieldset>
        <legend>Data Seminar</legend>
        <table style="width:50%">
        <tr>
          <td><?php echo $form->labelEx($model,'city'); ?></td>
          <td>
            <?php
              $city = array(
                'Jakarta' => 'Jakarta',
                'Surabaya' => 'Surabaya',
              );
            ?>
            <?php echo $form->dropDownList($model, 'city', $city, array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'city'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'class_choice'); ?></td>
          <td>
            <?php echo $form->dropDownList($model, 'class_choice', Cedp::model()->classChoice(), array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'class_choice'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'contact_via'); ?></td>
          <td>
            <?php echo $form->dropDownList($model, 'contact_via', Cedp::model()->contactVia(), array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'contact_via'); ?>
          </td>
        </tr>
        <tr>
          <td><?php echo $form->labelEx($model,'handout_lang'); ?></td>
          <td>
            <?php echo $form->dropDownList($model, 'handout_lang', Cedp::model()->handoutLang(), array('class' => 'full', 'required' => 'required')); ?>
            <?php echo $form->error($model, 'handout_lang'); ?>
          </td>
        </tr>
        </table>
      </fieldset>
      
      <fieldset>
        <legend>Please confirm captcha correctly</legend>
        <?php $form->widget('CCaptcha'); ?><br />
        <?php echo $form->textField($model, 'verifyCode'); ?>
        <?php echo $form->error($model, "verifyCode"); ?>
      </fieldset>

      <p>*) is required</p>
			<input type='submit' value='Submit' />
			<input type='submit' value='Reset' />
		<?php $this->endWidget(); ?>
	</div>

    <div class='rightPane'>
		<h2 class='differentAlign'>Our <span class='differentHeading'>Contact</span></h2>
		<div class="contact">
			<h3>ACSI Head Quarters</h3>
      731 Chapel Hills Drive Colorado Springs<br />
      CO 80920.3949<br />
      Phone : +1.719.528.6906<br />
      Fax : +1.719.531.0631<br />
      Email : info@acsiglobal.org
		</div>
    <div class="contact">
			<h3>ACSI Indonesia</h3>
      Komplek Ruko Klampis Megah B-25<br />
      Jl. Klampis Madya Utara I/6<br />
      Surabaya - Jawa Timur 60117<br />
      Phone/Fax : +62.31-591.0897, 591.3068<br />
      Phone : +62.31-592.9902<br />
      Mobile : +62.31-8193.5548<br />
      Email : acsi-indonesia@acsi.or.id<br />
      http://acsiglobal.org; acsi.or.id
		</div>
    <div class="contact">
			<h3>Indonesia Representative Office</h3>
      <b>Jakarta</b><br />
      Jl. Kwitang Raya No. 4, 3rd Floor<br />
      Senen - Jakarta Pusat 10420<br />
      Phone/Fax : +62.21-391.1207<br />
      Mobile : +62.31-3631-8020<br />
      Email : acsi-jakarta@acsi.or.id
		</div>
	</div>
</div>

<div class='spacer'>&nbsp;</div>